Neurological issues- acute injury vs degenerative

[Railbird]

Not sure if COTH recalls my weirdo sinus infection with my sweet 5 year old: Bad luck or am I missing something? Sinus infection from hell

Basically after 4 weeks doxy/stall rest/previcox following the sequestrum surgery, he has not come back normally. What started as some maybe-weakness seems to be progressing into some notable neurological issues and of course there’s no obvious answer here, but I thought I would ask anyways:

• Main symptoms: tripping, behavioral issues. Refuses to go down hills or will act out when pushed. Painful with neck manipulation. Struggles walking in tight circles. Occasionally will seem to “black out” and lose awareness of his surroundings, whether that’s from pain or mental issues it’s hard to say. Worse on the right than the left.
• EPM bloodwork negative. The month of doxy should have taken care of tick illness in theory. Horse has not shown any other signs of illness - no fever, weight loss, muscle wasting, etc.
• Sports med vet who examined him felt the most unusual thing was that he was extremely dull and had no skin reflexes on exam.
• Ultrasound of the neck didn’t show arthritic changes, neck X-rays from prepurchase 2 years ago didn’t show congenital abnormalities. Did show inflammation so we injected facets c5-t1 and subscapular with steroid, plus mesotherapy on the neck. There was a notable improvement for about a week and I’d say we are back to where we started if not worse.
• Did foot balance X-rays just to rule that out, all looked good there
• Sports med vet didn’t note any limb lameness that he felt wasn’t attributed to weird neurological type movement patterns- swinging legs wide etc.
• 2x CT scans haven’t noted anything in the brain/poll, whether or not that would make a difference I have no idea
• Guttural pouch scope did show a pigmented area that could be indicative of more I nternal melanomas
• Currently balder on his neck than the rest of his body and was very into being curried over the weekend in that area until he got too into it, reached around at his flank to scratch at it, and scrambled to the far side of his stall to stand with his legs out wide like he was on a trailer and stare at me bug eyed for about 30 seconds like he had no idea who I was or how I got there. He was fine after that and came back over for more scratches.

New Bolton can’t get him in for 6 weeks, sports med vet comes Friday to recheck and shoot new neck X-rays, and we will pull vitamin E levels. Seems like our options on the table are: some kind of traumatic neck injury happened which has been getting worse even with rest, EDM, or some other thing causing spinal compression in the absence of notable arthritis or a congenital issue. All these options suck. The only thing that in my mind doesn’t point to an overall degenerative issue is how painful his neck is, but I can’t really fathom what could be happening in a neck that keeps getting worse with just normal horse life, isn’t arthritis, and doesn’t respond to injections for more than a week. On the other hand, I also don’t know what kind of neck injury causes horses to lose their skin reflexes and periodically seem to forget who the person next to them is and how they got there.

Of course insurance plays a role here with not having medical coverage for wobblers and only mortality if he is graded 3/5 ataxic or higher, but I don’t know that the info we have points in that direction anyways.

As always, appreciate the collective experience of COTH. There’s always someone here who has already been down whichever weird road you find yourself on.

[Bonnie2]

If you didn’t have bad luck you would have no luck! This group of signs is very disturbing. Make sure everyone is extra careful handling him. Can’t help wondering if the sinus issues caused the current condition or if he has an underlying problem that caused both. Have you tried him on steroids? It won’t cure anything but it would be interesting to see if it alleviates the symptoms. Keep the insurance company informed and be clear about expiration dates. This doesn’t sound like it will end well. Deepest sympathies!

[Simkie]

Oh yikes, how scary. I’m so sorry you’re facing all of this.

Has your vet discussed using DMSO systemically? It’s kind of old school, but it can be tubed or used IV and acts to reduce inflammation. I’ve read and heard of it in particular when there’s a neuro injury like you’re describing.

[NaturallyHappy]

I’ve seen that, too! I’d forgotten - I’m glad you mentioned it.

[IPEsq]

My vet used IV DMSO on a horse who got mystery radial nerve paralysis. And on my horse after his scapular fracture (before fracture was diagnosed) because we were concerned about the whole brachial plexus complex as well as support limb laminitis. It is gross (very stinky), but might be worth a shot if you can’t get into the hospital for a little while.

[4horses]

I would go ahead and start a vitamin E supplement. Natural vitamin E that is, not the synthetic form.

I would probably want some antibiotics on board. Could be meningitis from the infection he had? I have a hard time believing that it’s unrelated. It would be the worst coincidence ever, for him to go in to develop wobblers or something.

[ClaireBear_NZ]

One of my horses had an acute neurological injury (he’d got himself tangled in an electric fence) and was ataxic behind although fine in front. He had IV DMSO for several days and I do think it really helped him recover. He came back 100% within a week but I did end up binning the rug he’d worn for the duration because the smell never really left.

[Railbird]

I have been hesitant to start Vitamin E or any kind of things that might mask symptoms before we have some kind of working diagnosis. With my luck it would just make things better enough the vets couldn’t pinpoint, but not actually fix it. We will pull the levels to check though.

The DMSO idea is interesting but I kind of file it under the same category of not wanting to treat symptoms before we have it diagnosed. We will see how tomorrow morning goes- I’m lucky to have a really great sports med vet and hopefully he will have an idea for a game plan

[atr]

Was he laid down for the surgery? I’m wondering whether something happened during the surgery or recovery that tweaked something.

I’m sorry for you and your horse. What a rotten situation.

[Simkie]

There’s a window in which nervey things can be addressed before you risk permanent damage. Nerves regenerate so slowly. I’d encourage you to focus less on “I need to know what exactly happened here” and more on addressing the symptoms you see. This is an emergency that needs care now.

Finding out exactly what happened in six weeks won’t matter much if too much time has passed to improve the horse. This is also painful and scary for him, and it’s really not fair to leave him in this state when you have tools at your disposal that could help.

[RedHorses]

If there is a physical impingement on the spinal cord, the symptoms will vary… If it’s in his neck the symptoms can change as his neck position changes.

Could the reaction in your last example (scratching his flank) have been either shock at losing his balance and scrambling to catch himself, or a reaction to a sudden nerve pain? The bug eyed stare could have been a WTF happened reaction?

I agree with this others about treating what you can ASAP. Jingling madly that you can get this resolved!

[beowulf]

Oh no. I am so sorry. That is an awful collection of symptoms.

I’m with others, start the IV DMSO ASAP. My vet did a daily DMSO/Baytril drip for one of my horses who was literally on death’s door. I could not believe how much it perked him up. Better than the torb cocktail that had enough punch in it to knock a cow’s udder off.

Put it this way - what would matter to you more in the end? The answer, or having a healthy horse back?

He is probably in so much pain right now too, which can sometimes mask the real issue and/or make it difficult to find the root of the problem, because they compensate everywhere. At baseline, you know he had something in his neck (noted on the PPE exam, is that right?) at one point - that’s a decent starting area.

Sinus infections are awful on a body - even a young otherwise healthy horse. It would not surprise me if the sinus infection precluded the body from healing appropriately from whatever it was that caused inflammation in the c5-t1.

The hair loss could be associated with whatever ABX he was on for the sinus infection. ABXs make them more prone to sunburn, he could be itchy from that and that caused hair loss. Incidentally or not, I have noticed in my own N=1 experience that horses with spinal issues tend to have very itchy necks, and itchy tails - not at the top where they scratch if they have worms, but towards the bottom of the tail.

Your collection of symptoms would make me think he could be graded 3/5 or higher. Talk to your vet about your insurance, they may be able to help.

Something to throw out there, not sure your horse’s management, but if his neck is that bad, pull any hay nets or high/raised grain or hay stations from the routine for a while.

No recent vaccinations, right?

I really hope your boy feels better soon, so sorry you are going through this. What a good owner you are to have pursued all these diagnostics in the first place - he is so lucky to have you.

[Peggy]

@atr

Was he laid down for the surgery? I’m wondering whether something happened during the surgery or recovery that tweaked something.

I had something like that happen. In hindsight there were signs of neurological issues before the incident but something clearly exacerbated them. Horse broke his jaw by catching it on the chain that comprised the stall latch. Never figured out if he torqued his neck struggling to get free or if it was a result of the surgery (I think they hang them upside down?) or antics coming out of anesthesia b

[Railbird]

Well, a bit of a plot twist. Dr Ober came back today, and he sheepishly said he was typing up the report to refer to new bolton and just got a feeling something was missing or not right, and he tries to follow that instinct on these NQR horses because it usually serves him well. So he re-examines him and the neck pain was better from last time but not zero, but Nugget was heinously back sore, like almost sat down from it. Neuro exam still not good with moving his feet back when placed down and tripping and circles etc but the back pain was much more notable than the neuro defecits.

So he asks to see him lunge and same as before, he was off on whichever leg was outside on the lunge, tried to stand up in the air and run me over when asked to go to the right and did a bunch of protesting and nearly fell down, so he decided to block both front feet and asked how long he had been wearing aluminum shoes. He did get shod for the first time right around when the sinus stuff started, and it all got much worse after the sequestrum surgery which also coincided with when he got his feet done by the new farrier up here, so I was kind of intrigued with that correlation. Blocking both front feet improved the behavioral stuff DRAMATICALLY. Did not fix the neuro type defecits, didn’t change the limping on the outside leg, and he still lost his balance getting his shoes pulled, but he stood quietly, snuggled, participated in what we were asking, etc.

@Simkie

Finding out exactly what happened in six weeks won’t matter much if too much time has passed to improve the horse. This is also painful and scary for him, and it’s really not fair to leave him in this state when you have tools at your disposal that could help.

I probably was not clear- I didn’t do anything solo as far as supplementing Vitamin E because I didn’t want to do so without being under a vet guidance and having a starting level, especially with him being on good pasture 12+ hours a day. He has had a vet exam more or less weekly since the beginning of June, and no one has suggested IV DMSO or vitamin E. Promise I’m not withholding vet care. I did ask today about the DMSO and Dr Ober said he uses it a lot but didn’t think it was appropriate in this specific circumstance.

So working plan at the moment is we pulled Vitamin E and some blood test that can detect a marker for EDM, pulled the shoes, putting him on Arquel, and doc would like to see him lunge in a routine to see how helping the feet changes the other symptoms. He felt that such a significant improvement in the overall demeanor from blocking the feet was notable enough to consider that some of the tripping and behavioral stuff and soreness elsewhere in the body could be from him just not wanting to put either front foot down. He did say to keep the new bolton appointment because he is not convinced that the feet are the whole story. I asked about whether another clinic that could get him in sooner would be worth investigating and he was pretty specific he wanted Dr Johnson there to see him and we needed to wait for her.

@atr

Was he laid down for the surgery? I’m wondering whether something happened during the surgery or recovery that tweaked something.

No, they were all done standing, but the sequestrum removal surgery involved a lot of physical force being applied to scrape off all that diseased bone, so I would not be shocked if that contributed in some way, but that is hard to tell.

Anyways, could be a red herring, but it was an interesting day to be sure.

[Paint_Party]

I’m also interested in whether the horse was down for any period of time during surgery. Had a similar experience as @Peggy.

Also, wondering if this could be a meningitis, presenting with a stiff neck and neuro symptoms, secondary to the sinus infection. Not unheard of in people.

[Railbird]

@Paint_Party

Also, wondering if this could be a meningitis, presenting with a stiff neck and neuro symptoms, secondary to the sinus infection. Not unheard of in people.

The thought occurred to me but I am pretty sure if that had been the case from several months back, we would have seen some kind of fever or weird bloodwork or seriously escalating symptoms based off my understanding.

[Railbird]

@beowulf

At baseline, you know he had something in his neck (noted on the PPE exam, is that right?) at one point - that’s a decent starting area.

No, I had his neck imaged on PPE just routinely because I would not purchase a horse with neck malformations or similar. It was squeaky clean then. The only imaging of the neck since then was when we first had the full lameness exam done 2.5 weeks ago and ultrasound showed inflammation in the joints but didn’t show bony changes, so that’s when we injected the area to take down the inflammation and did a week of bute. Helped for about a week, then noticed him starting tripping again last week so we went back to vet follow ups and trying to get a full neuro consult. Local vet had seen him the prior week and suspected EPM.

[IPEsq]

Does he have an ulcer history? I wonder if the meds and surgeries may have caused ulcers. Hear me out…if you take away the front foot pain you have major back soreness plus neuro looking behavior. I have seen ulcers cause enough discomfort in some horses (even mild ulcers) that horse appeared somewhat neuro from how they were guarding themselves.

[Railbird]

The thought has crossed my mind, having had a really gnarly ulcer horse before, but he’s fat, eats great, and got 1/4 tube of gastrogard a day surrounding the surgeries and I have had him on GutX when he finished up the GG, so it wasn’t top of my mind. Probably worth a round of sucralfate or similar to see if it helps, though. Will have to read up on the current thinking given I took a lengthy time off and came back thinking the gastrogard patent would have expired and it would be the promised land of plentiful cheap effective ulcer treatment in the year 2023 but seems not to be the case lol

[beowulf]

@Railbird

neck X-rays from prepurchase 2 years ago didn’t show congenital abnormalities. Did show inflammation so we injected facets c5-t1 and subscapular with steroid, plus mesotherapy on the neck.

Ah. I misunderstood because of the above, it sounded like it was in the same visit.

In any event with horses I’m a firm believer of Occam’s razor. I hope you get to the bottom of this.